Enhancing the use of technology in the long-term care sector in Canada: Insights from citizen panels and a national stakeholder dialogue.

Enhancing the use of technology in long-term care has been identified as a key part of broader efforts to strengthen the sector in the wake of the COVID-19 pandemic. To inform such efforts, we convened a series of citizen panels, followed by a national stakeholder dialogue with system leaders focused on reimagining the long-term care sector using technology. Key actions prioritized through the deliberations convened included: developing an innovation roadmap/agenda (including national standards and guidelines); using co-design approaches for the strengthening the long-term care sector and for technological innovation; identifying and coordinating existing innovation projects to support scale and spread; enabling rapid-learning and improvement cycles to support the development, evaluation, and implementation of new technologies; and using funding models that enable the flexibility needed for such rapid-learning cycles.

Information needs of francophone health care professionals and the public with regard to medical assistance in dying in Quebec: a qualitative study.

BACKGROUND: In 2016, the Canadian government legalized medical assistance in dying (MAiD) for adults with terminal illness. The objective of this study was to explore the information needs of health care professionals and members of the public regarding MAiD. METHODS: This was a qualitative study involving a 1-day face-to-face forum followed by a 3-week online forum across the province of Quebec conducted in June 2016. French-speaking participants targeted for the study included members of the public (citizens, patients and caregivers) and health care professionals. Participants were recruited through calls for applications to a patient partner network and via social media, and through mailing lists of partner professional and community organizations across Quebec. We used a purposeful sampling strategy to recruit a diverse group of participants. In the forums, deliberations were prompted by short informational videos about MAiD. We performed a thematic analysis to identify key information needs. RESULTS: Fifty members of the public and 35 health care professionals participated. Forty-three people participated in the face-to-face meeting, and 42 people participated online. Participants identified 32 information needs (22 expressed by both members of the public and health care professionals, and 10 specific to members of the public) regarding the definition of MAiD, eligibility criteria, and documenting and evaluating practices. Information needs varied along different stages of the patient's journey. Participants expressed the need to be informed about issues that go beyond the medical and legal aspects of MAiD (e.g., relational, symbolic, psychological and spiritual aspects). INTERPRETATION: The findings show that health care professionals and members of the public have common information needs regarding MAiD and seek information on the relational, emotional and symbolic aspects of this practice. These findings call for concerted efforts to build a common information base - covering dimensions that go beyond the medical and legal aspects of MAiD - to facilitate informed conversations among patients, health care professionals and members of the public.

Patient and public engagement in research and health system decision making: A systematic review of evaluation tools.

BACKGROUND: Patient and public engagement is growing, but evaluative efforts remain limited. Reviews looking at evaluation tools for patient engagement in individual decision making do exist, but no similar articles in research and health systems have been published. OBJECTIVE: Systematically review and appraise evaluation tools for patient and public engagement in research and health system decision making. METHODS: We searched literature published between January 1980 and February 2016. Electronic databases (Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO) were consulted, as well as grey literature obtained through Google, subject-matter experts, social media and engagement organization websites. Two independent reviewers appraised the evaluation tools based on 4 assessment criteria: scientific rigour, patient and public perspective, comprehensiveness and usability. RESULTS: In total, 10 663 unique references were identified, 27 were included. Most of these tools were developed in the last decade and were designed to support improvement of engagement activities. Only 11% of tools were explicitly based on a literature review, and just 7% were tested for reliability. Patients and members of the public were involved in designing 56% of the tools, mainly in the piloting stage, and 18.5% of tools were designed to report evaluation results to patients and the public. CONCLUSION: A growing number of evaluation tools are available to support patient and public engagement in research and health system decision making. However, the scientific rigour with which such evaluation tools are developed could be improved, as well as the level of patient and public engagement in their design and reporting.

Recommendations for patient engagement in patient-oriented emergency medicine research.

OBJECTIVE: To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research. METHODS: We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. RESULTS: We synthesized our literature review into categories including identification and engagement, patients' roles, perceived benefits, harms, and barriers to patient engagement; 40/75 (53% response rate) invited researchers completed our survey. Among respondents, 58% had engaged patients in research, and 83% intended to engage patients in future research. However, 95% stated that they need further guidance to engage patients. Our qualitative interviews revealed barriers to patient engagement, including the need for training and patient partner recruitment.Our panel recommends 1) an overarching positive recommendation to support patient engagement in EM research; 2) seven policy-level recommendations for CAEP to support the creation of a national patient council, to develop, adopt and adapt training material, guidelines, and tools for patient engagement, and to support increased patient engagement in EM research; and 3) nine pragmatic recommendations about engaging patients in the preparatory, execution, and translational phases of EM research. CONCLUSION: Patient engagement can improve EM research by helping researchers select meaningful outcomes, increase social acceptability of studies, and design knowledge translation strategies that target patients' needs.

Fostering K-12 students' global competencies

The environment in which children are growing up today is very different than that of previous generations. There has been tremendous innovation in how society operates, with the rapid expansion of technology, globalization of businesses, new careers and opportunities, and increasingly diverse communities. Students graduating from high school have tremendous opportunities to be personally successful, economically productive, and actively engaged. To capitalize on these opportunities however, it is critical that our education systems support students in acquiring the right competencies to navigate increasingly complex societies.

Supporting professional learning approaches to foster global competencies in K-12 education

Education is key to equipping individuals with the necessary skills to meaningfully contribute to society.(1) Rapid developments in technology, workforce changes and the effects of globalization mean that societies are evolving at a faster than ever pace. Responsive education systems are needed to properly prepare students with the required skill sets to meet these changing demands

Creating a rapid-learning health system in Ontario

Ontario has both a health system and a research system that are increasingly putting patients and rapid learning and improvement at their centre. For the health system, a recent notable example of such efforts was the Patients First Act 2016 which, among other things, mandated the creation of Patient and Family Advisory Councils at multiple levels in the health system,(4) the formalization of LHIN sub-regions as the focal point for local improvements to the patient experience, and the preparation of annual Quality Improvement Plans by many health organizations. For the research system, a notable example is the efforts by the Ministry of Health and Long-Term Care (MoHLTC) and the Ontario SPOR SUPPORT Unit (OSSU) to support the conduct and use of patient-oriented research.

identifying tax benefits or incentives to reduce poverty among older adults

Poverty reduction measures are an important approach to improving health and well-being.(2) A recent survey found that poverty among older adults was lower in 20 out of 35 OECD countries when compared to the population as a whole.(3) In Canada, while the prevalence of low income among older adults has declined since 1976, older adults are more likely to be towards the bottom of the income distribution.(2; 4) Living in poverty is of particular concern among older adult populations given the additional challenges that are often associated with aging (e.g., multimorbidity, reduced mobility and independence, and loss of community and social supports).

Examining the public provision and funding of PET-CT Imaging for non-cancer Indications

Positron emission tomography­computed tomography (better known as PET-CT) has revolutionized medical diagnosis since the first commercial systems reached the market in the early 2000s.(1) This advanced nuclear imaging technique combines a positron emission tomography (PET) scanner and an X-ray computed tomography (CT) scanner into a single machine. PET-CTs create threedimensional images, providing information about both the structure and function of cells and tissues in the body during a single imaging session.

Fostering an organizational culture supportive of evidence-informed policymaking

We identified a total of 21 relevant documents by searching Health Systems Evidence and running targeted searches in PubMed, with the search strategy for these databases detailed in Box 2. A document was included when it directly addressed the question posed for this rapid synthesis (i.e., it was specific to an organizational culture supportive of evidenceinformed policymaking) or, when such evidence was sparse, when it addressed a more general question about organizational culture that can be applied to the specific instance of evidence-informed policymaking. Among the documents, we found one overview of systematic reviews, eight systematic reviews, four nonsystematic reviews, seven primary studies, and one assessment tool that were deemed relevant. We provide more details about each review and single study in Appendix 1 and 2, respectively

Changing practice to achieve equity in Ontario's education sector

Ontario is home to people from more than 200 countries who speak more than 130 languages. Multiculturalism, human rights and diversity are core values embraced in the province.(1) The public education system can play a crucial role in supporting these core values by transcending socio-economic and ethno-cultural barriers, and helping students to become engaged, productive and responsible citizens.

Examining the coverage of pharmacogenetic tests and use of pharmacogenetic information at the population level

Our jurisdictional scan yielded no information about phamacogenetic tests that are publicly covered at the population level for select conditions across the jurisdictions reviewed. However, in reviewing the literature, we did find one primary study that examined coverage policies for individual pharmacogenetic tests among six U.S. insurance companies, and we detail the findings in Table 1. This study reveals that coverage policies for specific pharmacogenetic tests varied greatly across insurance companies, and that the majority of tests were deemed experimental/investigational and therefore not eligible for coverage.

Designing Integrated Approaches to Support People with Multimorbidity: Key Messages from Systematic Reviews, Health System Leaders and Citizens.

BACKGROUND: Living with multiple chronic conditions (multimorbidity) - and facing complex, uncoordinated and fragmented care - is part of the daily life of a growing number of Canadians. METHODS: We undertook: a knowledge synthesis; a "gap analysis" of existing systematic reviews; an issue brief that synthesized the available evidence about the problem, three options for addressing it and implementation considerations; a stakeholder dialogue involving key health-system leaders; and a citizen panel. RESULTS: We identified several recommendations for actions that can be taken, including: developing evidence-based guidance that providers can use to help achieve goals set by patients; embracing approaches to supporting self-management; supporting greater communication and collaboration across healthcare providers as well as between healthcare providers and patients; and investing more efforts in health promotion and disease prevention. CONCLUSIONS: Our results point to the need for health system decision-makers to support bottom-up, person-centred approaches to developing models of care that are tailored for people with multimorbidity and support a research agenda to address the identified priorities.

Developing a rapid-response program for health system decision-makers in Canada: findings from an issue brief and stakeholder dialogue.

BACKGROUND: There is currently no mechanism in place outside of government to provide rapid syntheses of the best available research evidence about problems, options and/or implementation considerations related to a specific health system challenge that Canadian health system decision-makers need to address in a timely manner. A 'rapid-response' program could address this gap by providing access to optimally packaged, relevant and high-quality research evidence over short periods of time (i.e. days or weeks). METHODS: We prepared an issue brief that describes the best available research evidence related to the problem, three broad features of a program that addresses the problem and implementation considerations. We identified systematic reviews by searching for organization-targeted implementation strategies in Health Systems Evidence ( www.healthsystemsevidence.org ) and drew on an existing analytical framework for how knowledge-brokering organizations can organize themselves to operationalize the program features. The issue brief was then used to inform a half-day stakeholder dialogue about whether and how to develop a rapid-response program for health system decision-makers in Canada. We thematically synthesized the deliberations. RESULTS: We found very few relevant systematic reviews but used frameworks and examples from existing programs to 1) outline key considerations for organizing a rapid-response program,, 2) determine what can be done in timelines ranging from 3 to 10 and 30 business days, and 3) define success and measure it. The 11 dialogue participants from across Canada largely agreed with the content presented in the brief, but noted two key challenges to consider: securing stable, long-term funding and finding a way to effectively and equitably manage the expected demand. Recommendations and suggestions for next steps from dialogue participants included taking an 'organic' approach to developing a pan-Canadian network and including jurisdictional scans as a type of product to deliver through the program (rather than only syntheses of research evidence). CONCLUSIONS: Dialogue participants clearly signalled that there is an appetite for a rapid-response program for health system decision-makers in Canada. To 'organically' build such a program, we are currently engaging in efforts to build partnerships and secure funding to support the creation of a pan-Canadian network for conducting rapid syntheses for health system decision-makers in Canada.

Evaluating deliberative dialogues focussed on healthy public policy.

BACKGROUND: Deliberative dialogues have recently captured attention in the public health policy arena because they have the potential to address several key factors that influence the use of research evidence in policymaking. We conducted an evaluation of three deliberative dialogues convened in Canada by the National Collaborating Centre for Healthy Public Policy in order to learn more about deliberative dialogues focussed on healthy public policy. METHODS: The evaluation included a formative assessment of participants' views about and experiences with ten key design features of the dialogues, and a summative assessment of participants' intention to use research evidence of the type that was discussed at the dialogue. We surveyed participants immediately after each dialogue was completed and again six months later. We analyzed the ratings using descriptive statistics and the written comments by conducting a thematic analysis. RESULTS: A total of 31 individuals participated in the three deliberative dialogues that we evaluated. The response rate was 94% (N = 29; policymakers (n = 9), stakeholders (n = 18), researchers (n = 2)) for the initial survey and 56% (n = 14) for the follow-up. All 10 of the design features that we examined as part of the formative evaluation were rated favourably by all participant groups. The findings of the summative evaluation demonstrated a mean behavioural intention score of 5.8 on a scale from 1 (strongly disagree) to 7 (strongly agree). CONCLUSION: Our findings reinforce the promise of deliberative dialogues as a strategy for supporting evidence-informed public health policies. Additional work is needed to understand more about which design elements work in which situations and for different issues, and whether intention to use research evidence is a suitable substitute for measuring actual behaviour change.

Introducing the patient's perspective in hospital health technology assessment (HTA): the views of HTA producers, hospital managers and patients.

BACKGROUND: The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patient's perspective is taken into consideration when such decisions are made. OBJECTIVE: To explore the practices, perceptions and views of the various HTA stakeholders concerning patient involvement in HTA at the local level. METHOD: Data were collected using semi-structured interviews with 24 HTA producers and hospital managers and two focus groups with a total of 13 patient representatives. RESULTS: Patient representatives generally showed considerable interest in being involved in HTA. Our findings support the hypothesis that the patient perspective contributes to a more accurate and contextualized assessment of health technologies and produces HTA reports that are more useful for decision makers. They also suggest that participation throughout the assessment process could empower patients and improve their knowledge. Barriers to patient involvement in HTA at the local level are also discussed as well as potential strategies to overcome them. DISCUSSION AND CONCLUSION: This study contributes to knowledge that could guide interventions in favour of patient participation in HTA activities at the local level. Experimenting with different patient involvement strategies and assessing their impact is needed to provide evidence that will inform future interventions of this kind.

Assessing the impacts of citizen deliberations on the health technology process.

OBJECTIVES: We assessed the impacts of a Citizens' Reference Panel on the deliberations of a provincial health technology advisory committee and its secretariat, which produce, recommendations for the use of health technologies in Ontario, Canada. METHODS: A fourteen-member citizens' reference panel was convened five times between February 2009 and May 2010 to participate in informed, facilitated discussions to inform the assessment of individual technologies and provincial health technology assessment processes more generally. Qualitative data collection methods were used to document observed and perceived impacts of the citizens' panel on the health technology assessment (HTA) process. RESULTS: Panel impacts were observed for all technologies reviewed, at two different stages in the HTA process, and represented macro- (raising awareness) and micro-level (informing recommendations) impacts. These impacts were shaped by periodic opportunities for direct and brokered exchange between the Panel and the expert advisory committee to clarify roles, foster accountability, and build trust. Our findings offer new insights about one of the main considerations in the design of deliberative participatory structures-how to maintain the independence of a citizens' panel while ensuring that their input is considered at key junctures in the HTA process. CONCLUSIONS: Citizens' panels can exert various impacts on the HTA process. Ensuring these types of structures include opportunities for direct exchange between citizens and experts, to clarify roles, promote accountability, and build trust will facilitate their impacts in a variety of settings.

Identifying optimal treatment approaches for people with multimorbidity in Ontario

Multimorbidity is part of the daily life of a growing number of Ontarians who must manage multiple chronic conditions. As Fortin et al. observed, "patients with multiple conditions are the rule rather than the exception in primary care." Multimorbidity not only has a significant impact on healthcare utilization and costs, but it is expected to affect quality of life, ability to work, employability, disability, process of care and mortality.(3) Despite the burden of multimorbidity, patients often receive care that is "fragmented, incomplete, inefficient, and ineffective."(3) Thus, there have been growing calls for changes to health systems and clinical decision-making processes to more effectively and efficiently provide the complex care required by those with multimorbidity.

Citizens' perspectives on personalized medicine: a qualitative public deliberation study.

Our objective was to explore citizens' informed and reasoned values and expectations of personalized medicine, a timely yet novel genomics policy issue. A qualitative, public deliberation study was undertaken using a citizens' reference panel on health technologies, established to provide input to the health technology assessment process in Ontario, Canada. The citizens' panel consisted of five women and nine men, aged 18-71 years, with one member selected from each health authority region. There were shared expectations among the citizens' panel members for the potential of personalized medicine technologies to improve care, provided they are deemed clinically valid and effective. These expectations were tempered by concerns about value for money and the possibility that access to treatment may be limited by personalized medicine tests used to stratify patients. Although they questioned the presumed technological imperative presented by personalized medicine technologies, they called for increased efforts to prepare the health-care system to effectively integrate these technologies. This study represents an early but important effort to explore public values toward personalized medicine. This study also provides evidence of the public's ability to form coherent judgments about a new policy issue. Concerned that personalized tests might be used to ration care, they suggested that treatment should be made available if patients wanted it, irrespective of tests that indicate little benefit. This issue raises clinical and policy challenges that may undermine the value of personalized medicine. Further efforts to deliberate with the public are warranted to inform effective, efficient and equitable translation of personalized medicine.